Evidence of widespread mechanical hyperalgesia but not exercise induced analgesia in athletes with mild patellar tendinopathy compared to pain-free matched controls:a blinded exploratory study

OBJECTIVE: To assess centrally induced pain processing with pressure pain thresholds (PPT) bilaterally and remotely in active volleyball and basketball athletes with mild patellar tendinopathy compared to asymptomatic control athletes. Secondary objective was to explore the role of exercised induced analgesia during a training session in athletes with patellar tendinopathy. DESIGN: In this exploratory study, PPTs of 21 patellar tendinopathy athletes and 16 age and sex matched asymptomatic team members were measured by a blinded assessor bilaterally on the patellar tendon and unilaterally on the elbow extensor tendon with a pressure algometer before, during and after a regular training session. RESULTS: Patellar tendinopathy athletes had a significantly higher average body mass index compared to asymptomatic athletes (mean difference 1.75 (95%CI 0.35, 3.15), p= 0.02). At baseline, athletes with patellar tendinopathy showed lowered PPTs in the affected knee (p=0.001), unaffected knee (p<0.001), and elbow (p=0.01) compared to controls. No clear patterns were identified to explain between group differences in PPTs before, during and after exercise. CONCLUSION: This exploratory study found primary and secondary mechanical hyperalgesia in athletes with patellar tendinopathy compared asymptomatic athletes. Further research is required on the effects of an acute exercise bout on pain thresholds in this population

A cross-sectional analysis of motivation and decision-making in referrals to lifestyle interventions by primary care general practitioners: a call for guidance

Aim: To explore 1) GPs´ motivation to refer to lifestyle interventions and to investigate the association between GPs’ own lifestyle-behaviors and their referral behavior, and 2) patient indicators in the decision-making process of the GPs’ referral to lifestyle interventions. Method: A cross-sectional study was conducted among 99 Dutch primary care GPs. Their motivation to refer was assessed by beliefs regarding lifestyle interventions. GPs’ referral behaviors were assessed - considering referral and self-reported actual referral - and their own lifestyle behaviors - physical activity, dieting, being overweight). Decision-making regarding referring patients to lifestyle interventions was assessed by imposed patient indicators, spontaneously suggested decisive patient indicators, and by case-based referring (vignettes). Results: A substantial group of GPs was not motivated for referral to lifestyle interventions. GPs’ refer behavior was significantly associated with their perceived subjective norm, behavioral control, and their own physical activity and diet. Most important patient indicators in referral to lifestyle interventions were somatic indicators, and patients’ motivation for lifestyle interventions. Conclusions: GPs motivation and referral behavior might be improved by providing them with tailored resources about evidence based lifestyle interventions, with support from allied health professionals, and with official guidelines for a more objective and systematic screening of patients

The barrier-belief approach in the counseling of physical activity

Objective: To understand inactivity and relapse from PA, and to develop theory-based behaviour change strategies to stimulate and support maintenance of PA. Methods: We conducted a literature search to explore barriers to PA. Social cognitive theories and empirical evidence were evaluated and guided the process developing a theoretical framework and counselling strategies. Results: A theoretical framework is presented to understand why people do not engage in PA and often relapse once they started PA. A distinction is made between three related types of BBs. In PA counselling these three beliefs are addressed using four different BB behaviour change strategies. Conclusion: BB counselling aims to develop an individual pattern of PA for the long term that is adapted to the (often limited) motivation of the client, thereby preventing the occurrence of BBs. The client will learn to cope with factors that may inhibit PA in the future. Practice implications: The BBs approach composes a way of counselling around the central construct of barrier-beliefs to stimulate engagement in PA independently, in the long term

Chronic pain and severe disuse syndrome:long-term outcome of an inpatient multidisciplinary cognitive behavioural programme

Objective: Patients with chronic pain and severe disuse syndrome have pain with physiological, psychological and social adaptations. The duration and severity of complaints, combined with previously failed treatments, makes them unsuitable for treatment in primary care. Design: A prospective waiting list controlled study. Patients: A total of 32 patients with chronic pain for at least one year and severe disuse syndrome were included in an inpatient multidisciplinary cognitive behavioural treatment. Methods: Patients were assessed before the waiting list period, before the clinical phase, after the clinical phase and after follow-ups of 6 months and one year. The visual analogue scale for pain and fatigue were assessed. Muscle strength of the arms and legs, arm endurance and a 6-minute walking test were used to assess physical outcome. The Symptom Check-list-90, RAND-36, pain cognition list and the Tampa scale for kinesiophobia were used to assess psychological outcome. Results: Long-term significant (p <0.001) improvements were found for pain, fatigue, walking distance, muscle strength, anxiety, depression, somatization, negative self-efficacy, and catastrophizing in the intervention period. Conclusion: An inpatient multidisciplinary cognitive behavioural programme is beneficial for patients with chronic pain and a severe disuse syndrome

Pain neuroscience education in persistent painful tendinopathies: A scoping review from the Tendon PNE Network

Objective To conduct and report a scoping review of the available evidence of the effects and content of pain neuroscience education for patients with persistent painful tendinopathies. Methods PubMed, Embase, Web of Science, CINAHL, SPORTDiscus, and grey literature databases were searched from database inception to May 2022. Randomised and non-randomised controlled trials, non-controlled clinical trials, cohort studies, case series, case studies including people with persistent painful tendinopathy aged ≥18 years, a pain education intervention, and in English were included. Studies were excluded if they were cross-sectional studies, reviews, editorials, abstracts, or full-text not available or if included heterogeneous study cohorts, patients with tendon rupture, or patients with systemic diseases. Results five studies (n = 164) were included. Pain neuroscience education entailed face-to-face discussion sessions or educational materials including videos, brochures, paper drawings, and review questions. All studies used pain neuroscience education in conjunction with other interventions, obtaining significant benefits in outcomes related to pain, physical performance, or self-reported function, among others. Conclusions The application of pain neuroscience education in conjunction with other interventions seemed to improve several outcomes. However, considering the current knowledge about tendon pain and the scarcity of well-designed trials studying pain neuroscience education in tendinopathy, additional research is needed.Funding for open acces charge: Universidad de Málaga / CBU